Provider Demographics
NPI:1821002288
Name:PARK, WILLIAM BYUNG HO (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BYUNG HO
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9828 GARDEN GROVE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1659
Mailing Address - Country:US
Mailing Address - Phone:714-530-9633
Mailing Address - Fax:714-530-4410
Practice Address - Street 1:9828 GARDEN GROVE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1659
Practice Address - Country:US
Practice Address - Phone:714-530-9633
Practice Address - Fax:714-530-4410
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52866C207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A528661OtherBLUE SHIELD
CA00A528661Medicaid
CAA52866CMedicare PIN
CA00A528661Medicaid